New Way To Diagnose Prediabetes

Prediabetes, the condition of having elevated serum glucose levels that are above the normal range but not yet at the level of diabetes, is an asymptomatic precursor to type 2 diabetes mellitus.

Identifying patients who are prediabetic is important because it affords them valuable time to enact lifestyle changes that could delay or prevent the onset of full type 2 diabetes mellitus. At present, only measuring serum glucose or insulin can determine if a patient is prediabetic.

Obesity is a major risk factor for the development of prediabetes. A hallmark of obesity is elevated free fatty acid (FFA) levels. Therefore it has been hypothesized that high FFA levels can be used to predict certain conditions that are secondary to obesity, such as cardiovascular disease and diabetes, even in the absence of the other factors.

Researchers from the University of Hawaii Cancer Center have tested this association with diabetes. They say that elevated FFA levels correlate with diabetes and can diagnose a patient as prediabetic up to 10 years prior to actual diabetes diagnosis – years before insulin and glucose levels can indicate.

The researchers examined certain patients from 4 studies conducted in affiliation with a hospital affiliated with Shanghai Jiao Tong University: a cross-sectional obesity study, a 10-year diabetes longitudinal study, a clinical trial of gastric bypass surgery in obese patients with type 2 diabetes, and a dietary intervention trial in obese but metabolically normal patients. In total, they looked at 452 obese or overweight patients.

They found that the overweight patients with type 2 diabetes had significantly increased FFA levels compared with their non-diabetic counterparts. When they specifically examined the 10-year longitudinal study, they found similar results. Out of the 62 overweight patients they looked at from that study, 50 of them developed metabolic syndrome by the end of 10 years. These patients also had elevated FFA levels at baseline. The researchers also found that unsaturated fatty acids were more correlated with metabolic syndrome than saturated fatty acids.

These findings indicate that FFA levels should be targeted for normalization in patients with obesity. Measuring FFA levels at regular intervals may help doctors identify patients who are prediabetic earlier than before. A similar study should be conducted on metabolically unhealthy patients who are not overweight or obese to see if the correlation stands.

Practice Pearls:

Patients with obesity who have elevated FFA levels at baseline are at increased risk of developing diabetes. Therefore elevated FFA levels can be seen as an earlier marker of prediabetes.

Unsaturated fatty acids are more associated with diabetes and metabolic syndrome than saturated fatty acids.

This analysis did not look at patients who are not overweight or obese, so these results are not generalizable to them.